Thursday, July 8, 2010

Obesity & The Myth of the Lazy Worker

We all know the mantra from various health organizations both governmental and non-governmental: "eat less, exercise more." That's the solution, we are told, to the "obesity epidemic" that continues to sweep across North America and beyond. The basic idea behind this is that people are overweight because they are lazy gluttons. We see various represenations of this myth on both the right and the left of the political spectrum. "We consume too much," say the environmentalists. "Fat people are lazy," say the right. I have written on this previously but it's worth re-stating, especially in the light of two new studies that I'll discuss in moment.
I was drawn to thinking about this discourse on obesity a couple of days ago while having a conversation with someone regarding the financial meltdown in the US real estate market. The problem, the dominant US discourse runs, is that banks were forced to lend to poor people who got in debt over their heads and then couldn't pay their mortgages. That then reminded me of the arguments faced by the people of Greece to justify imposing a harsh austerity package that will drastically roll back average living standards in that country. The problem, say the commentators, is that the Greeks have had it too easy. Greek workers are lazy and over-compensated with "generous" retirement packages, generous vacation packages, generous social services and education. You get the gist.
There's a pattern here. All the problems of our society are the result of the ignorant masses who just don't understand. If only they/we would allow our social betters to shape and reshape the social order to solve problems without protesting (like some of us did at the G20), then things would all be fine. It's rather convenient since we didn't get to make any of the decisions that got us into these messes in the first place. It wasn't working people who decided after World War Two that the best way to spend government transportation dollars was to build millions of miles of highway infrastructure across the USA and Canada rather than investing in public transit. It isn't working people who are fundamentally driving urban sprawl and big box malls - it is developers trying to maximize profits. Yet "overconsumptionist" arguments suggest that it is the greedy aspiration of working people - to own new lawn mowers, new whipper-snippers and new big screen TVs - that is driving global warming and sweatshops in the third world.
How does this relate back to obesity and food? Back in the early 1970s a committee was formed, the United States Select Committee On Nutrition and Human Needs, chaired by future presidential hopeful George McGovern. It began by focusing on hunger but then in 1974 expanded its mandate to look over "over-eating." One of the legacies of this committee was the strongly enhanced notion of a link between high fat diets, obesity and sedentary lifestyles. It led to the creation of the food pyramid, which placed carbohydrates - whole grains - at the bottom. In other words carbs were the energy foundation of a healthy diet. Most of the major conclusions - eat less, exercise more - are still the foundation of the food pyramid. This outcome was controversial and its effects can be measured, as noted by Lierre Keith in her book The Vegetarian Myth. This is from a quote in a review on the blog of Dr. Eades.

And some scientists knew ahead of time that they would be. Phil Handler, the president of hte National Academy of Scientists asked Congress, “What right has the federal government to propose that the American people conduct a vast nutritional experiment, with themselves as subjects, on the strength of so very little evidence that it will do them any good?” Dr. Pete Ahrens, an expert on cholesterol metabolism, told the McGovern committee that the effects of a low-fat diet weren’t a scientific matter but “a betting matter.”

It’s twenty-five years later and we aren’t winning this bet. Each US American now eats sixty pounds more grain per annum and thirty pounds more cheap sugars, mostly from corn. [Is it any wonder we're all fat?]

Now, I think this might well overstate the power of the policy shift in terms of dietary recommendation. What is more interesting is that this Select Committee, from its founding to its closure and conversion into the Dietary Guidelines for Americans, spanned the period from the end of Keynesian liberalism in American into the austerity and beginning of the multi-generational rollback of living standards that we are still in the grip of. I believe that the shift from focusing on hunger in America to focusing on over-eating in America reflected a more general ideological and economic shift in society. As such, these dietary recommendation really presage what was tending to happen anyway - though it certainly reinforced and justified that trend. Basically, as American living standards stagnated and declined from their 1973 peak there was a growing reliance upon empty, cheap calories. The growth of the two income household as a necessity to sustain the post-war lifestyle, necessitated the growth in fast food and processed food products. And the general sense of a squeeze on the pocketbook drew Americans towards purchasing cheaper but still tasty foods.
In some ways the degradation of food in the post-Keynesian era is a stellar example of a more general process by which the inexorable decline was hidden. Cheap goods produced in even lower wage districts - China & the rest of Asia, Mexican maquilladoras, etc - helped cover up for the fact that things weren't getting better year after year as they had done for 20-years prior to the oil slump. And cheap food, heavily salted, filled with trans fats and loaded with sugar, covered up for the fact that where once Americans ate quality food (at least most Americans), they now were filling up on garbage. I have discussed this more than once elsewhere.
It has been suggested that living in the suburbs and leading a sedentary life because of our dependence upon cars is making us fat. I would argue that this lifestyle is making us soft; reducing muscle tone, flexibility, etc. But that's not the reason we're accumulating adipose tissue at such high rates. This argument comes in many ways from a book by Gary Taubes entitled Good Calories, Bad Calories, which challenges the dominant view of the role of macronutrients. Check out my review and then get yourself a copy. His basic argument is that the body operates on the basis homeostasis (ie. a stable state - for instance, we keep our body temperature around 37.5 degrees Celsius, regardless of the external temperature) and that this principle negates the idea that exercise would reduce fat on the principle of a simplified version of the Second Law of Thermodynamics. The basic application of this law in the area of obesity is as follows: calories in - calories out = weight gain/loss. Therefore, if you increase the number of calories you burn, you ought to lose weight. Except that the body is a complex machine and when you begin to work out one of the first things you notice is an increase in hunger. Your body needs more fuel. Now, you can deny yourself but the likelihood that you can go through your life feeling hunger as some sort of viable lifestyle - unless it's imposed by poverty or circumstance - is absurd. It's also extremely unhealthy to deny your body the nutrients that it needs. It's telling you you're hungry for a reason. Now, numerous dieticians for the past 75 years (at least) have been saying that exercise doesn't reduce body mass but it still sticks in the popular consciousness. Now along come these two studies. The first is from Indiana University and it says basically that exercise doesn't reduce weight, except in white women.

"It may seem intuitive that greater amounts of exercise lead to less obesity, but an Indiana University study has found that this conventional wisdom applies primarily to white women."

Now, my guess is that white women aren't from another planet and so there's a good chance that there's something else going on that is an independent variable causing white women who exercise to lose weight - compared to say African-American women. My guess is that white women are of a generally higher income status in the US and are thus more likely to eat more whole foods, be more likely to stay at home and thus prepare their own meals, etc. The study generates an absurd assumption that adding exercise at work would solve the problem without any evidence.
The second study from the Peninsula Medical School in Plymouth, UK followed a cohort of school children for 11-years and found that there was no relationship between level of physical activity and obesity. What they concluded was much more interesting (and in line with Taube's argument) and takes that Second Law of Thermodynamics and puts it on its head.

"Physical activity had no impact on weight change, but weight clearly led to less activity."

In other words, as these kids became overweight, physical activity became increasingly difficult and was thus reduced. Taube's takes the same approach to obesity and food, basing it on some well established science, arguing that people aren't fat because they eat too much, rather they eat too much because they're fat. Or, to clarify the point - eating a high carb diet causes the body to produce an excess of insulin and rapidly store the consumed food energy as fat tissue, leaving the body hungry for food energy.
Ever notice how that high carb dinner seemed to be just a distant memory within an hour, while that big steak just sits in your belly for hours? It's not an illusion. Excess sugar is dangerous for your body and carbs - especially refined carbs like white flour, white rice, sugar, white potatoes, etc. - are rapidly absorbed and broken down into sugar. Your body spikes your insulin levels in order to clear all that sugar energy from your body, converting it into fat tissue. So, while you add fat you don't actually feed your body, leading to the apparent irony that the obese are hungry all the time because their cells are literally starving. All of which is why it's more correct to say that obesity in America is just another face of hunger, disguised by garbage. Americans aren't over-eating, they're starving to death, it's just that this form of starvation doesn't lead to kwashiorkor it leads to diabetes, heart attack, stroke, dementia and obesity.